Rehabilitation of the thrower’s elbow


Injuries to the elbow occur often in the overhead athlete. The repetitive overhead motion involved in throwing is responsible for unique and sportspecific patterns of elbow injuries. These are caused by chronic stress overload or repetitive microtraumatic stress observed during the overhead pitching motion as the elbow extends at over 2300 8/s, producing a medial shear force of 300 N and compressive force of 900 N. In addition, the valgus stress applied to the elbow during the acceleration phase of throwing is 64 Nm , which exceeds the ultimate tensile strength of the ulnar collateral ligament (UCL). Thus, the medial aspect of the elbow undergoes tremendous tension (distraction) forces, and the lateral aspect is forcefully compressed during the throw. The overhead athlete is susceptible to specific elbow injuries. A number of forces act on the elbow during the act of throwing, including valgus stress with tension across the medial aspect of the elbow. These forces are maximal during the acceleration phase of throwing. Compression forces are also applied to the lateral aspect of the elbow during the throwing motion. The posterior compartment is subject to tensile, compressive, and torsional forces during acceleration and deceleration phases. This may result in valgus extension overload within the posterior compartment, potentially leading to osteophyte formation, stress fractures of the olecranon, or physeal injury.

     This article provides an overview of general rehabilitation principles for the thrower’s elbow. Specific nonoperative and postoperative treatment guidelines for the thrower’s elbow are also discussed.

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